CT-measurement predicts shortening of stable intertrochanteric hip fractures

Intertrochanteric (IT) hip fractures can be treated with sliding hip screws (SHS) or cephalomedullary nails (CMN) based on the stability of the fracture. This stability is affected by the initial impaction of the fracture which can be difficult to assess. The aim of this paper is to develop specific pre-operative computed tomography (CT) measurements of IT fractures which are predictive of post-operative shortening.

A retrospective review was performed of 141 patients with AO/OTA 31A1 or 31A2 fracture patterns, who had pre-operative radiographs and CT scans, and who were treated with a SHS or a CMN. Pre-operative and post-operative imaging of IT fractures were analyzed for those fractures that shortened ≥15 mm post-fixation.

11 fractures shortened ≥15 mm with CMN being protective of shortening (6/36 SHS versus 5/105 CMN, p = 0.0268). A novel measurement made on the pre-operative CT scan called the cortical thin point (CTP) detected differences between patients with <15 mm and ≥15 mm of post-operative shortening for the SHS group (p = 0.0375). CTP was found to be a reliable predictor for post-operative shortening of ≥15 mm when a cutoff threshold of 9 mm was used in the SHS group (p = 0.0161).

Measuring the CTP is predictive of post-operative shortening after fixation of an IT fracture with a SHS. CMN fixation may be protective of shortening. Patients with a CTP of ≤9 mm are at risk for fracture site shortening of more than 15 mm when treated with a SHS.